Stress Echocardiography: Abnormal Tissue Doppler Imaging in the Absence of Cardiac Allograft Vasculopathy in Heart Transplant Recipients

Background: The most significant predictor of long‐term survival in heart transplant patients is the development of accelerated cardiac allograft vasculopathy (CAV). Several studies have demonstrated the usefulness of dobutamine stress echocardiography (DSE) for screening CAV, by detecting regional wall motion abnormalities. Tissue Doppler imaging (TDI)‐derived indices during DSE allow for the early detection of ischemic heart disease (IHD), prior to a reduction in regional or global systolic function. These indices include a reduction in annular systolic velocity (S′), a decrease in early diastolic annular velocity (E′), and prolongation of time to E′. In cardiac transplant patients, the application of these TDI abnormalities during DSE remains unknown. Objective: The objective of this study was to evaluate the pattern of (TDI‐derived indices of systolic and diastolic function during DSE in cardiac transplant patients without evidence of CAV. Methods: A retrospective evaluation of 30 patients (mean age 54 ± 11 years) who had both DSE and coronary angiography was performed. The control group consisted of 15 patients referred to rule out coronary artery disease while the study group consisted of 15 cardiac transplant patients referred for routine annual follow‐up. During each stage of DSE, tissue Doppler measurements of systolic (S′), early (E′), and late (A′) diastolic velocities of the lateral annulus were taken. Results: All 30 patients had normal DSE based on systolic regional function and normal coronary angiograms with no stenosis >50%. There was no difference in hemodynamic parameters during the DSE at baseline and with stress. Despite normal coronaries, cardiac transplant patients demonstrated lower S′, E′, and A′ velocities at peak stress compared to the control patients. Conclusion: Dobutamine‐induced augmentation of TDI velocities of the lateral annulus, normally observed in the absence of ischemia in nontransplanted adults, is reduced in cardiac transplant recipients.     

Tissue Doppler velocities of mitral annulus and NT-proBNP in patients with heart failure

BACKGROUND: It has been shown that pulsed wave tissue Doppler velocities of mitral annulus correlate well with left ventricular (LV) diastolic and systolic functions. It is not yet clear whether these velocities can be used to estimate left ventricular dysfunction in an unselected population of patients with clinical signs and symptoms of heart failure (HF). AIM: To determine whether LV mitral annulus velocities measured by tissue Doppler imaging (TDI) correlate with plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with HF. METHODS AND RESULTS: Early diastolic (E(m)) and systolic (S(m)) TDI velocities of septal and lateral mitral annulus were measured in 50 patients with HF together with other conventional echocardiographic parameters, and compared with plasma NT-proBNP levels. Significant correlations were found between NT-proBNP level and E(m) velocity (r=-0.79), S(m) velocity (r=-0.43), early transmitral to E(m) velocity ratio (r=0.38), LV end diastolic diameter (r=0.29), LV ejection fraction (r=-0.44) and tricuspid regurgitant velocity (r=0.31). In multiple regression model (R(2)=0.733), the E(m) velocity was the most important predictor of NT-proBNP level. CONCLUSIONS: Early diastolic mitral annulus velocity measured by TDI correlates strongly with plasma NT-proBNP levels, and provides a simple, accurate and reproducible echocardiographic index of heart failure.     

Mitral Annular Velocities Generated by Speckle Tracking Imaging: Reproducibility and Correlation with Tissue Doppler Velocities

Background: Early diastolic mitral annular velocities (E′) are routinely generated by tissue Doppler imaging (TDI), an angle‐dependent technique. Velocity vector imaging (VVI) lacks this limitation. Normal VVI E′ values and their correlation with TDI E′ are unknown. Methods: E′ by VVI and TDI were compared in 100 patients. Results: VVI velocities are lower and correlate moderately with TDI velocities for medial E′ (r = 0.405) and mildly for lateral E′ (r = 0.278) and are image quality dependent. In patients with diastolic or systolic dysfunction, no correlation was found. E′ < 0.06 m/s by VVI for the medial and lateral annulus can detect abnormal diastolic function with sensitivity of 90% and 77%, respectively, and with specificity of 56% and 52%, respectively. Conclusions: E′ by VVI is lower than by TDI with a poor agreement between the measurements, which are therefore not interchangeable. Although VVI can be performed offline, this method is dependent on image quality. (Echocardiography 2010;27:637‐643)     

Effects of continuous positive airway pressure therapy on right ventricular function assessment by tissue Doppler imaging in patients with obstructive sleep apnea syndrome

Objectives: The effects of continuous positive airway pressure (CPAP) therapy on right ventricular (RV) function in patients with obstructive sleep apnea syndrome (OSAS) has not been previously studied by tissue Doppler imaging (TDI). The aim of this study was to assess RV function using TDI in patients with OSAS before and after CPAP therapy. Methods: Twenty‐eight patients with newly diagnosed OSAS in the absence of any confounding factors and 18 controls were included in this study. The peak systolic velocity (S′m), early (E′m) and late (A′m) diastolic myocardial peak velocities at tricuspid lateral annulus, isovolumic acceleration (IVA), myocardial precontraction time (PCT′m), myocardial contraction time (CT′m), and myocardial relaxation time (RT′m) were measured. All echocardiographic parameters were calculated 6 months after CPAP therapy. Results: The RV diastolic parameters such as E′m velocity and E′m‐to‐A′m ratio were significantly lower, RT′m was significantly prolonged, A′m velocity was similar in patients with OSAS compared to controls; and the RV systolic parameters such as IVA and CT′m were significantly lower and S′m was similar in patients with OSAS compared to controls. At the end of the treatment, 20 of 28 patients were compliant with CPAP therapy. E′m velocity, E′m‐to‐A′m ratio, IVA, and CT′m increased, PCT′m, PCT′m‐to‐CT′m ratio, and RT′m decreased significantly after therapy, whereas S′m velocity and A′m velocity did not change after CPAP treatment in the compliant patients. Conclusion: OSAS is associated with RV systolic and diastolic dysfunction, and 6 months of CPAP therapy improves the RV systolic and diastolic dysfunction.     

Speckle tracking-derived mitral annular velocities predict mortality in patients with acute coronary syndrome

Background: Myocardial ischemia can impair myocardial relaxation and result in increased left ventricular (LV) diastolic pressure. Noninvasive measurements of mitral annular velocities have been used to evaluate LV diastolic pressure. We sought to determine whether mitral annular velocities, derived from novel speckle tracking echocardiography (STE), could predict mortality in patients with acute coronary syndrome (ACS). Methods: A total of 246 patients with ACS were retrospectively studied. STE was analyzed offline with the sample volume placed on septal, lateral, inferior, and anterior mitral annulus. Peak early (E′) and late (A′) diastolic velocities of the mitral annulus were measured and averaged from the four regions. Peak early diastolic mitral inflow velocity (E) was obtained using pulsed‐wave Doppler. Results: Lower E′ (P = 0.03), lower A′ (P = 0.001), higher E′/A′ ratio (P = 0.007), and higher E/E′ ratio (P = 0.003) were independently associated with increased risk of death with adjustment for clinical and echocardiographic variables over the follow‐up period of 21 months. The optimal cutoff value of E/E′ ratio derived from the receiver operating characteristic analysis for predicting death was 30 (area under the curve = 0.65). E/E′ ratio greater than 30 was predictive of death in univariate (HR, 2.40; CI, 1.42–4.06; P = 0.001) and multivariate (adjusted HR, 1.91; CI, 1.09–3.32; P = 0.02) models. Conclusion: The measurements of mitral annular velocities by STE are predictive of mortality in patients with ACS. (Echocardiography 2012;29:560‐567)     

Quantitative assessment of systolic and diastolic ventricular function with tissue Doppler imaging after Fontan type of operation

BACKGROUND: There is evidence that "inappropriate hypertrophy" of the single left ventricle, which occurs as a result of acute preload reduction, leads to adverse consequences on ventricular function. However, a systematic study of the capability of tissue Doppler imaging (TDI) to assess systolic and diastolic ventricular functions after the Fontan procedure is still missing. METHODS: Twenty-four postoperative patients aged 12-33 years were prospectively evaluated with two-dimensional echocardiography equipped with TDI capabilities. Nineteen age-matched normal subjects were selected as controls. Good-quality echoes for the measurement of ejection fractions were available in 21 patients. Ten patients (group 1) had systolic dysfunction (ejection fraction < 50%), and 11 patients (group 2) had normal systolic function. Peak systolic and diastolic wall velocities were acquired from the two-chamber view in the myocardia and mitral annulus. RESULTS: Compared with controls, the Fontan patients had a significantly reduced peak systolic velocity at wall and annulus sites. A linear correlation existed between ejection fraction and systolic myocardial velocity from the annular sites. Group 1 patients had lower wall velocities and lower annulus velocities both in systole and diastole. Group 2 patients had preserved systolic velocities but decreased regional and annular early diastolic velocities, suggesting impaired filling. Multiple correlation analysis showed a relation between peak early diastolic mitral velocity and ventricular ejection fraction, mean mitral annular motion at systole, mass/volume ratio, and the number of years post Fontan revision. CONCLUSIONS: Myocardial velocities recorded after the Fontan operation give insight into systolic and diastolic ventricular functions. The peak systolic mitral annular velocity correlated well with the ventricular ejection fraction. The peak early diastolic velocity and the ratio between the early and late diastolic mitral annular velocity are reduced and reflect diastolic dysfunction even in the presence of normal systolic ejection fraction.     

多普勒组织成像评价肥厚型心肌病左室舒张功能

目的应用多普勒组织成像脉冲技术测量二尖瓣环舒张速度,以评价肥厚型心肌病左室舒张功能.方法对90例肥厚型心肌病患者及50例正常人进行常规超声心电图及多普勒组织成像检查,测量各房室内径,室壁厚度,射血分数及二尖瓣环各点舒张早期峰值速度(Ea)、舒张晚期峰值速度(Aa).两组指标比较采用成组t检验.结果肥厚型心肌病患者室间隔厚度(25.5±6.6)mm,左室后壁厚度(9.9±2.3)mm,左室内径(42.9±5.9)mm,左房内径(39.9±4.7)mm,LVEF(71.9±4.3)%,二尖瓣血流E/A为1.42±0.7.肥厚型心肌病患者Ea较正常人减低.Aa无明显差异.结论肥厚型心肌病左室长轴主动松弛功能较正常人减低.     

The correlation of left atrial volume index to the level of N-terminal pro-BNP in heart failure with a preserved ejection fraction

Background: Patients with heart failure with a preserved ejection fraction (HFPEF) have high N‐terminal pro‐B‐type natriuretic peptide (NT‐pro‐BNP) level and a high ratio of early transmitral inflow to diastolic velocity of the mitral annulus (E/E′) derived from tissue Doppler imaging (TDI). Because left atrial volume indexed to body surface area (LAVI) is believed to reflect chronic diastolic dysfunction, we assessed the ability of LAVI and E/E′ ratio to predict NT‐pro‐BNP level in patients with HFPEF. Methods: One hundred forty‐eight patients with HFPEF (ejection fraction ≥ 50%, NT‐pro‐BNP ≥ 100 pg/ml) underwent conventional echocardiography including LAVI and E/E′ ratio, which were compared with NT‐pro‐BNP level. Results: In the overall patient population, modest correlations were found between NT‐pro‐BNP level and peak systolic TDI (S′) (P = 0.009), LAVI (P = 0.009), and E/E′ ratio (P = 0.017). However, in patients with E/E′ ratio ≥13, LAVI was the most important predictor of NT‐pro‐BNP level (P < 0.001), whereas in those with E/E′ ratio <13 it was S′ (P < 0.001) in multivariate analysis. Conclusion: In patients with HFPEF evidenced by high NT‐pro‐BNP level, LAVI correlates with NT‐pro‐BNP level in the setting of elevated E/E′ ratio. However, in the setting of low E/E′ ratio, LAVI does not seem to be associated with NT‐pro‐BNP level.     

Comparison between tissue Doppler imaging and velocity-encoded magnetic resonance imaging for measurement of myocardial velocities, assessment of left ventricular dyssynchrony, and estimation of left ventricular filling pressures in patients with ischemic cardiomyopathy

Velocity-encoded magnetic resonance imaging (VE-MRI), commonly used to perform flow measurements, can be applied for myocardial velocity analysis, similar to tissue Doppler imaging (TDI). In this study, a comparison between VE-MRI and TDI was performed for the assessment of left ventricular dyssynchrony and left ventricular filling pressures. Ten healthy volunteers and 22 patients with heart failure secondary to ischemic cardiomyopathy underwent both VE-MRI and TDI. Longitudinal myocardial peak systolic and diastolic velocities and time to peak systolic velocity (Ts) were measured with both techniques at the level of left ventricular septum and lateral wall. To quantify left ventricular dyssynchrony, the delay in Ts between basal septum and lateral wall was calculated (SLD) and patients were categorized into 3 groups: minimal (SLD <30 ms), intermediate (SLD = 30 to 60 ms) and extensive (SLD >60 ms) left ventricular dyssynchrony. The ratio of transmitral E wave velocity and mitral annulus septal early velocity (E/E' ratio) was also assessed, and patients were divided into 3 groups: normal (E/E' <8), probably abnormal (E/E' = 8 to 15), and elevated (E/E' >15) left ventricular filling pressures. Excellent correlations were observed for peak systolic velocity and peak diastolic velocity (r = 0.95, p <0.001) measured with TDI and VE-MRI. A small bias (p <0.001) of -1.1 +/- 1.1 cm/s for peak systolic velocity and of -0.45 +/- 1.03 cm/s for peak diastolic velocity was noted between the 2 techniques. A strong correlation was also noted between Ts measured with TDI and VE-MRI (r = 0.97, p <0.001) without a significant difference. TDI and VE-MRI showed an excellent agreement for left ventricular dyssynchrony and left ventricular filling pressures classification with a weighted kappa of 0.96 and 0.91, respectively. In conclusion, TDI and VE-MRI are highly concordant and can be used interchangeably for the assessment of left ventricular dyssynchrony and filling pressures.     

Usefulness of a new proposed tissue Doppler imaging global function index in hypertrophic cardiomyopathy

BACKGROUND: A global function index (GFI) derived from tissue Doppler imaging (TDI) has been proposed to improve the diagnosis of hypertrophic cardiomyopathy (HCM). We aimed to evaluate the usefulness of this index in a large selected HCM population. METHODS: GFI =[E/Ea]/Sa, was calculated at mitral annulus lateral and septal borders in 164 HCM patients and in 40 healthy volunteers. Group comparisons and correlations between GFI and other variables were performed. RESULTS: Of the 164 patients, 69 (42%) had a peak gradient >30 mmHg in the left ventricle outflow tract (LVOT). GFI (lateral or septal) was not normally distributed. There were differences among controls, obstructive HCM, and nonobstructive HCM (P < 0.0001), but significant overlap of GFI values were observed between groups. GFI was correlated to septal thickness (r = 0.44; P < 0.0001), left atrial diameter (r = 0.52; P < 0.0001), and LVOT gradient (r = 0.58; P < 0.0001). CONCLUSION: In a selected HCM population, GFI was limited by its asymmetrical distribution and significant overlap of values between groups. Further studies are necessary to verify the reliability of GFI in the clinical practice and its position among other tissue Doppler indices.     

Tissue Doppler imaging provides incremental prognostic value in patients with systemic hypertension and left ventricular hypertrophy

OBJECTIVES: We sought to determine the prognostic value of left ventricular (LV) mitral annular velocities measured by tissue Doppler imaging (TDI) in hypertensive patients with echocardiographic evidence of LV hypertrophy. BACKGROUND: Echo LV hypertrophy and LV geometry provide additional predictive value of all-cause mortality beyond traditional cardiovascular risk factors. Limited data exist regarding the predictive value of TDI velocities for cardiovascular risk stratification in treated hypertensive patients. METHODS: Two-dimensional and Doppler echocardiograms were obtained in 252 consecutive subjects, including 174 subjects with systemic hypertension and 78 age-matched normal subjects. The end point was cardiac death in subsequent median follow-up of 19 months. RESULTS: Nineteen patients (7.54%) died of cardiac causes. The TDI mitral annulus systolic velocity and the early diastolic mitral annular velocity (Em) were significantly lower in the non-survivors (all P < 0.001). The pseudonormal (PN) or restrictive filling pattern (RFP) was associated with cardiac mortality. The other parameters associated with cardiac mortality were LV ejection fraction, LV mass index, inter-ventricular septal wall thickness in diastole and the ratio of early mitral inflow to early myocardial velocity. In multivariate analysis, Em, inter-ventricular septal wall thickness in diastole and either PN or RFP were the strongest predictors. The addition of Em < 3.5 cm/s significantly improved the outcome of a model that contained clinical risk factors, inter-ventricular septal wall thickness in diastole > 1.4 cm and either PN or RFP (P = 0.043). CONCLUSIONS: Early diastolic mitral annulus velocity measured by TDI provides prognostic information, incremental to clinical data and standard echocardiographic variables, for risk stratification of hypertensive patients under treatment.     

多普勒组织成像测定二尖瓣环运动速度评价急性心肌梗死后患者左心室功能

目的 :应用多普勒组织成像 (DTI)技术测定二尖瓣环运动速度 ,定量分析急性心肌梗死后患者左心室收缩和舒张功能。方法 :研究对象为 6 1例确诊首次急性心肌梗死的患者和 2 0例正常人。常规行超声心动图检查及DTI技术测定二尖瓣环运动速度频谱。记录心尖四腔、心尖二腔和心尖长轴切面多普勒组织成像二尖瓣环运动速度。测定二尖瓣环运动速度参数包括 :二尖瓣环收缩速度 (Sm) ,二尖瓣环舒张早期速度 (Em) ,二尖瓣环舒张晚期速度 (Am) ,二尖瓣环舒张早期速度的比值 (E Em)。结果 :与对照组相比 ,急性心肌梗死后患者DTI可敏感地显示出二尖瓣环收缩和舒张运动速度显著下降(P <0 0 5 ) ;E Em也有显著差别 (P =0 0 13)。DTI二尖瓣环收缩速度与二尖瓣环舒张早期速度之间 ,二尖瓣环收缩速度与左心室射血分数和室壁运动积分之间存在显著的相关性。平均二尖瓣环收缩期速度≥ 8 9cm s预测射血分数 (EF)≥ 5 5 %的敏感性、特异性分别为 88 2 %、70 % ,准确率为 81 5 %。结论 :DTI测量二尖瓣环运动速度 ,作为定量检测急性心肌梗死患者近期心脏功能状态的新方法 ,具有一定的应用价值。     

Left ventricular hypertrophy and its regression in essential arterial hypertension. A tissue Doppler imaging study

The mitral annulus velocities of Doppler transmitral flow and pulsed-wave tissue Doppler imaging (TDI) were sampled by echocardiography for the assessment of left ventricular (LV) diastolic function in 118 never-treated essential hypertensive patients with normal systolic function and compared with those of 59 normotensive healthy subjects matched for age and sex. A selected group (n = 26) of the hypertensive study population was observed after 1 year of pharmacologic antihypertensive treatment to determine the behavior of TDI parameters in relation to eventual regression of LV hypertrophy (LVH). We found that the TDI early myocardial diastolic wave (E(m)) was significantly lower both in concentric and eccentric LVH. In addition, TDI late myocardial diastolic wave (A(m)) was significantly higher in concentric remodeling and concentric and eccentric hypertrophy. The TDI E(m)/A(m) ratio was significantly lower in all geometric remodeling subgroups. The E/A ratio Doppler transmitral flow velocity measured showed that of the 118 patients, only 32 (25%) could really be discriminated from normal, whereas individual analysis for TDI E(m)/A(m) at the mitral annulus septal level showed that of 118 patients 108 (91%) could be discriminated from normal P < .001). The LV mass was significantly less after 1 year of treatment (LVH regression), and TDI parameters showed a trend toward normalization, in particular of TDI E(m)/A(m) at the annular septal level. Pulsed-wave TDI analysis could enable not only the early assessment of whether a patient is still in an adaptive or compensatory phase before transition to irreversible damage (pathologic phase) but also the detection of precocious LV global diastolic dysfunction. With regard to this, more extensive randomized studies are needed to evaluate the effect of different pharmacologic treatments (calcium antagonists, beta-blockers, angiotensin I and II inhibitors) on TDI parameters.     

Systolic and Diastolic Ventricular Function Assessed by Tissue Doppler Imaging in Children with Chronic Kidney Disease

Chronic kidney disease (CKD) is associated with elevated cardiovascular risk even during childhood. Tissue Doppler is a sensitive technique for the assessment of ventricular dysfunction with relatively little data available in children with CKD. We report a prospective cross‐sectional echocardiographic study at a tertiary center. Forty‐nine patients with median (range) age 11.2 years (6.9–17.9), weight 39.6 kg (23.6–99.7) and height 146 cm (122–185). Thirty‐one patients were male. Median duration of follow‐up for CKD was 7.1 years (range 0.13–16.9). Patients were in CKD stage 3 (n = 37) or 4 (n = 12). Mitral valve E‐wave, A‐wave, and E/A ratio showed mean (SD) z‐scores of 0.08 (0.93), 0.12 (0.82) and ?0.13 (0.84), respectively. Tissue Doppler imaging (TDI) at the lateral mitral valve annulus showed e′, a′, s′, and E/e′ z‐scores mean (SD) ?1.10 (0.76), ?0.29 (0.92), ?1.2 (0.7), and 0.86 (1.1), respectively. There was a significant negative correlation of e′ and s′ z‐score with patient age. E/e′ ratio correlated positively with patient age. Blood pressure, left ventricular mass, and relative wall thickness did not correlate with tissue Doppler measurements. The e′ and s′ velocities correlated significantly with each other, suggesting an interaction of systolic and diastolic dysfunction. Children with CKD may have abnormalities of systolic and diastolic ventricular function on TDI, which are not evident on blood pool Doppler. The tissue Doppler results are consistent with worsening ventricular function in older patients.     

Assessment of left ventricular systolic and diastolic function by tissue Doppler analysis in patients with hypertension with or without hyperuricemia

OBJECTIVE: Hyperuricemia (HU) is a well-recognized risk factor for cardiovascular diseases. The independence of this association from other confounding factors has remained controversial. The possible contributory effect of HU to myocardial impairment produced by hypertension (HT), however, has not been clarified yet. The study was designed to assess the left ventricular (LV) systolic and diastolic function in patients with HT with or without HU. Tissue Doppler imaging (TDI) was used for detailed analysis as this method was superior to other conventional echocardiographic techniques. METHODS: The study participants consisted of 27 patients (men 56%, mean age+/-SD; 55+/-10 years) with HT without HU, and 27 patients with HT with HU (men 62%, mean age+/-SD; 56+/-9 years), and 27 age-matched healthy control participants (men 57%, mean age+/-SD; 53+/-11 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and TDI. Peak systolic myocardial velocity at mitral annulus (Sm), mitral inflow velocities and early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), peak systolic mitral annular velocity, Em/Am, and myocardial performance index were calculated by TDI. RESULTS: Mitral inflow velocities and tissue Doppler-derived mitral annular diastolic velocities were significantly different in the patient groups (HT without HU and HT with HU) compared with the control cases. Tissue Doppler-derived myocardial performance index (LV-MPI) was significantly impaired in the patient groups compared with those of the control's (0.48+/-0.09, 0.53+/-0.07, and 0.39+/-0.07, respectively, P<0.001). Significant differences were also observed between the patients who had HT without HU and the patients who had HT with HU regarding LV-MPI. Significant correlations were observed between the serum uric acid levels and LV function parameters.     

Relationship between outflow obstruction and left ventricular functional impairment in hypertrophic cardiomyopathy: a Doppler echocardiographic study

Left ventricular outflow tract (LVOT) obstruction is predictive of a worse outcome in hypertrophic cardiomyopathy (HCM). In a detailed Doppler echocardiographic study of 178 selected HCM patients, the group of patients (n = 73) with the obstructive form (resting peak gradient > or = 30 mmHg) presented more hypertrophy and poorer systolic and diastolic left ventricular (LV) functions than the HCM group (n = 105) without obstruction. LVOT peak gradient was positively correlated with hypertrophy (P < 0.0001) and negatively to tissue Doppler mitral annulus systolic (P = 0.0001) and early diastolic (P < 0.0001) velocities. The gradient significantly correlated with E/Ea ratio (r = 0.67; P < 0.0001). By multiple regression, LVOT gradient was related to E/Ea, LV maximal thickness and left atrial size. In comparison with patients without obstruction, patients with obstruction presented greater hypertrophy (P < 0.0001), lower systolic and early diastolic mitral annulus velocities (both P < 0.0001), higher E/Ea ratio (P < 0.0001) and higher global function index (P < 0.0001). In HCM, beyond the effects on hypertrophy, LVOT obstruction is an independent determinant of LV functional abnormalities.     

Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value

OBJECTIVES: The aim of this study was to ascertain if left ventricular mitral annulus velocities measured by tissue Doppler imaging (TDI) are more powerful predictors of outcome compared with clinical data and standard Doppler-echocardiographic parameters. BACKGROUND: Tissue Doppler imaging of basal or mitral annulus velocities provides rapid assessment of ventricular long axis function. But it is not known if TDI-derived velocities in systole and diastole add incremental value and are superior to the standard Doppler-echocardiographic measurements as a predictor of outcome. METHODS: The study population consisted of 518 subjects, 353 with cardiac disease and 165 normal subjects who had full Doppler two-dimensional-echocardiographic studies with measurement of mitral inflow velocities in early and late diastole, E-wave deceleration time (DT), peak systolic mitral annular velocity (Sm) early and late diastolic mitral annular velocity (Em and Am) by TDI, early diastolic flow propagation velocity, and standard chamber dimensions. All subjects were followed up for two years. The end point was cardiac death. RESULTS: Tissue Doppler imaging mitral annulus systolic and diastolic velocities were all significantly lower in the non-survivors (all p < 0.05) as was DT (p = 0.024). In the Cox model the best predictors of mortality were Em, Sm, Am, left ventricular ejection fraction, left ventricular mass, and left atrial diameter in systole (LADs). By backward stepwise analysis Em and LADs were the strongest predictors. After forcing the TDI measurements into the covariate model with clinical and mitral DT <0.16 s, Em provided significant incremental value for predicting cardiac mortality (p = 0.004). CONCLUSIONS: Mitral annulus velocity measured by TDI in early diastole gives incremental predictive power for cardiac mortality compared to clinical data and standard echocardiographic measurements. This easily available measurement adds significant value in the clinical management of cardiac patients.     

尿毒症维持性血液透析患者左心室构型和功能的超声心动图研究

目的 评价尿毒症维持性血液透析患者的左心室形态学及舒张、收缩功能.方法 入选尿毒症维持性血液透析患者40例(尿毒症组),正常人45例(对照组).应用常规超声心动图、组织多普勒、实时三维超声心动图的多项指标对比分析尿毒症组左心室形态学改变、左心室重构类型;分析左心窒舒张和收缩功能变化,并对舒张功能异常进行分级;评价左心窜收缩及舒张的同步性.结果 尿毒症组的室壁厚度、左心室质量指数、左心室质量/容积比值显著性高于对照组(P<0.01),左心室构型以向心型肥厚为主(占50.0%),其次为向心型重构和偏心型肥厚(各占17.5%).尿毒症组的各项舒张功能指标与对照组差异有统计学意义(P<0.05),舒张功能异常以松弛功能受损类型居多(占85.0%),其中38.2%伴有左心室充盈压升高.尿毒症组的左心室射血分数、每搏量与对照组差异无统计学意义,但组织多普勒二尖瓣环收缩期运动速度显著低于对照组(P<0.05).左心室收缩不同步指标两组差异无统计学意义,舒张不同步指标尿毒症组显著高于对照组(P<0.05).结论 左心室肥厚、心肌质量增加和左心室舒张功能异常是尿毒症维持性血透患者心肌损害最突出的特征,舒张功能异常的出现早于收缩功能异常.     

Alterations in left ventricular structure and diastolic function in professional football players: assessment by tissue Doppler imaging and left ventricular flow propagation velocity

BACKGROUND: Long-term regular exercise is associated with physiologic and morphologic cardiac alterations. Tissue Doppler imaging (TDI) and ventricular early flow propagation velocity (Vp) are new tolls in the evaluation of myocardial function. We sought to compare TDI and Vp findings in professional football players and age-adjusted sedentary controls to assess the effect of regular athletic training on myocardial function. METHODS: Twenty-four professional football players and age-, sex-, and weight-adjusted 20 control subjects underwent standard Doppler echocardiography pulsed TDI, performed parasternal four-chamber views by placing sample volume septal and lateral side of mitral annulus and lateral tricuspid annulus. Vp values were obtained by measuring the slope delineated by first aliasing velocity from the mitral tips toward the apex by using apical four-chamber color M-mode Doppler images. RESULTS: Age, body surface area, blood pressure, and heart rate were comparable between two groups. Football players had significantly increased LV mass, mass index (due to both higher wall thickness and end-diastolic diameter), end-systolic and end-diastolic volume, left atrial diameter, and decreased transmitral diastolic late velocity. In athletes TDI analysis showed significantly increased mitral annulus septal DTI peak early diastolic (e) velocity (0.22 +/- 0.04 vs 0.19 +/- 0.04, P < 0.05), lateral DTI peak e velocity (0.19 +/- 0.03 vs 0.16 +/- 0.02, P < 0.05) and lateral DTI e/a peak velocity ratio (1.96 +/- 0.41 and 1.66 +/- 0.23, P < 0.05). The ratio of transmitral peak early diastolic velocity (E) to e in both lateral (4.72 +/- 1.20 vs 5.95 +/- 1.38, P = 0.007) and septal (3.90 +/- 0.80 vs 5.25 +/- 1.50, P = 0.002) side of mitral annulus were significantly lower in athletes. In Vp evaluation, we found higher Vp values (60.52 +/- 6.95 in athletes and 56.56 +/- 4.24 in controls, P = 0.03) in football players. CONCLUSIONS: Professional football playing is associated with morphologic alteration in left ventricle and left atrium and improvement in left ventricle diastolic function that can be detected by TDI and Vp. These techniques may be new tools to define and quantitate the degree of LV diastolic adaptations to endurance exercise.     

应用组织多普勒成像技术对前壁心肌梗死左心室舒张功能的诊断研究

目的应用组织多普勒成像技术(DTI)诊断前壁心肌梗死左心室舒张功能。方法陈旧性前壁心肌梗死组患者45例,对照组健康成年人42例。均行二维超声心动图及DTI检查。结果心肌梗死组与对照组DTI测值比较:心肌梗死组梗死节段收缩期波峰值速度(Vs),舒张早期波峰值速度(Ve)明显低于对照组。二尖瓣环DTI心肌梗死组舒张期早期速度(Ea)明显低于对照组,而舒张晚期速度无显著差异。结论DTI为定量分析左心室舒张功能提供了有效检测手段。